Dr Chris Paton

The United States Medical Licensing Examination is a three-step assessment co-administered by the Federation of State Medical Boards and the National Board of Medical Examiners. Passing all three steps is required for a doctor to be licensed to practise medicine in any US state.

Step 1 covers basic science and is taken during or after the preclinical years of medical school. Since 2022 it is reported as pass/fail rather than a three-digit score — a change that has had wide implications for residency selection. Step 2 Clinical Knowledge tests applied clinical knowledge and is taken in the clinical years; it continues to be reported as a scored exam and now carries much of the weight in residency applications previously attached to Step 1. Step 3 is taken during residency and assesses readiness for unsupervised clinical practice.

For international medical graduates seeking US residency through the Educational Commission for Foreign Medical Graduates (ECFMG), Steps 1 and 2 CK are part of the certification process. Specific licensing requirements and the residency match process change frequently — rely on the USMLE and ECFMG websites rather than any third-party summary.